Full wrist fusion device

ABSTRACT

Disclosed is a device for total wrist fusion that includes (a) a first section, which is preferably a plate, that is positioned under the skin on top of the forearm, wrist and potentially part of the hand and connected to one or more of the radius or carpal bones, (b) a second section, which is preferably in the shape of an awl and is received in the cannula of the third metacarpal bone. Optionally, an anti-rotational third section may be included, which can connect to the top of the third metacarpal bone.

FIELD OF THE INVENTION

The present invention is related to a device and method that provides full wrist fusion.

BACKGROUND OF THE INVENTION

Generally, wrist fusion apparatuses are used in patients with post-traumatic or degenerative wrist arthritis, conditions involving significant loss of bone substance, or failed total and partial wrist arthrodesis. Wrist arthrodesis can also be utilized in patients with complex fractures of the wrist, or with rheumatoid arthritis.

It is common for some types of wrist fusion apparatuses to extend from the radius to a metacarpal, particularly the third metacarpal, of the hand. Wrist fusion apparatuses of this variety are typically fastened both to the radius and to the third metacarpal by bone screws, and wrist fusion apparatuses of this type also therefore overlie the carpus area and the bones of the carpus area, which are positioned between the radius and the metacarpal bones. As known to those of skill in the art, bone grafts can be packed between the radius, the carpus area bones, and the metacarpals after such a wrist fusion plate is in place, and the bone grafts typically will bond with the adjacent bones in order to create a fused bone mass at the wrist joint.

Because wrist fusion plate apparatuses and methods require attachment of a portion of the wrist fusion plate to one or more of the metacarpals of the hand, they can cause undesirable disadvantages, such as the development of extensor tendinitis at the prominent distal end of the plate (which may necessitate removal of the plate and a second surgical procedure).

SUMMARY OF THE INVENTION

The present disclosure generally relates to a device for application to a wrist joint for use in an orthopaedic procedure, and, more particularly, to a wrist fusion plate for fusing a wrist joint. The wrist fusion device of the invention may be applicable for correction of bone deformation due to arthritis, rheumatoid arthritis, inflammatory diseases such as rheumatic fever or tuberculosis, genetic disorders of the bone, or for setting a wrist fracture.

Aspects of the present device include a first section, most preferably in the form of a metal bar or plate, that is positioned over the top of the forearm and extends past the wrist to fuse the wrist to the forearm and preferably fuse the bones in the wrist. The device further includes a second section integrally formed with or connected to the first section. The second section preferably narrows to the shape of a spike or awl. In use, an appropriate incision is made, such as lengthwise along the hand, wrist and forearm. The wrist is bent and the second section is pushed under the skin of the hand until it is properly seated inside of the cannula of the third metacarpal bone (the material in the cannula may be loosened first, using any suitable technique or device). One the second section is in place, the wrist is preferably straightened and the first section is placed under the skin across the wrist and onto the top the forearm. The plate is then secured using any suitable technique, such as bone screws that pass through apertures on the plate and into one or more of the radius and/or carpal bones.

A device according to the invention may include an anti-rotational third section. The third section may be connected to or integrally formed with the rest of the device. One aspect of the anti-rotational device could be a plate that extends upward and outward, above the second section, and is secured by one or more fasteners to the top of the third metacarpal bone.

The one or more fasteners may also be received in the part of the second section that is positioned in the cannula of the third metacarpal to provide additional anti-rotational stability. Further, an anti-rotational structure may be provided that includes no third section, but merely one or more fasteners that pass through, and are connected to, the top of the third metacarpal bone and that are also received in the second section.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective, side view of a device according to aspects of the invention.

FIG. 2 is a top view of the device of FIG. 1.

FIG. 3 is a perspective, side view of the device of FIG. 1 with the second section inserted in the cannula of the third metacarpal.

FIG. 4 is a partial, side perspective view of a device according to aspects of the invention.

FIG. 5 is a side, perspective view of a device according to aspects of the invention with the second section inserted into the cannula of the third metacarpal and the third section attached to the top of the third metacarpal.

FIG. 6 is the device of FIG. 5 fully connected to a patient's forearm, wrist and hand.

FIG. 7 is another device according to aspects of the invention showing how it is positioned on patient's forearm, wrist and hand.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Turning now to the Figures, where the purpose is to describe preferred embodiments according to the invention and not limit same, FIG. 1 shows a perspective side view of a device 10 according to aspects of the invention. Device 10 has a first section 20 and a second section 50. In one preferred embodiment device 10 has an overall length of between 90 and 150 mm, and is most preferably about 120 mm in length, and is comprised of stainless steel although any suitable material for permanent placement in the body would suffice.

First section 20 is configured to fit under the skin of the forearm and wrist and connect to the radius bone and one or more carpal bones in the forearm and/or wrist in order to secure section 20. FIGS. 6 and 7 illustrate a device 10 according to the invention fully inserted and attached.

First section 20 is preferably an elongated plate having a length of 45 mm-75 mm, and most preferably about 60 mm, a thickness of between 3 and 4 mm, and most preferably about 3.5 mm, and a width of 9-15 mm, and most preferably about 11 mm. First section 20 includes a first end 22, apertures 24, a top surface 26 and a bottom surface 28. Apertures 24 pass from top surface 26 through bottom surface 28 to enable bone screws (which means any device suitable to connect first section 20 to one or more bones in the forearm and/or wrist) 30, which are shown in FIGS. 6 and 7, to pass through and connect to a bone, such as the radius and/or a carpal bone. Screws 30 are preferably standard bone screws known in the art. As shown in FIG. 5, drill guides 40 may be associated with each aperture 26 to assist in quickly positioning and drilling screws 30.

As shown in FIG. 7, openings 24 may be formed as compression slots 24A capable of accepting either one or two screws 30. If formed as compression slots, the ends of each slot farthest from the hand are sloped inward so that a screw 30 positioned at that location will push against the sloped surface and press section 20A away from the hand to create compression along the bone. If the slot 24A is long enough another screw 30 may be positioned, for example, in slotted retainer 24B, to secure device 10.

First section 20 also preferably includes a bended portion, or bend, 32. Bend 32 is at a preferred angle of about 10°-20°, is positioned at the wrist and marks the transition from the portion of device 10 on the forearm to the portion on the top of the hand. In a preferred embodiment, the bend has a drop D of between 0.5 and 1.5, and most preferably about 1.0 cm, and a length of between 15 and 25 mm, and most preferably 20 mm. Alternatively, first section 20 may be straight.

There are preferably three or more apertures 24 (or 24A) on first section 20, and most preferably five with one located at about the center of the wrist.

Second section 50 is either connected to or (most preferably) integrally formed with first section 20. As shown, after or during the bend 32, device 10 narrows and conforms in shape to form second end 50, although it could conform in shape to form second end 50 at any suitable location, whether or not device 10 has a bend 32. In this embodiment, second end 50 has an end 52 and a cylindrical body 54. Depending on the overall shape of device 10, second section 50 may extend upward at a 10°-20° angle, and most preferably about 15°, from the position at which it meets first portion 20, or extend straight from that position, or extend at any suitable angle. As shown, second section 50 is between 30 and 50 mm, and most preferably about 40 mm in length. The portion that extends into the cannula of the third metacarpal is preferably 3-4 mm, and most preferably about 3.5 mm in diameter. Second section 50 may include either longitudinal ribs, latitudinal ribs, or both.

An optional third section 100 is an anti-rotational section that helps prevent device 10 from rotating. Preferably third section 100 is a separate piece attached to device 10 immediately after bend 32 or at any suitable location. Third section 100 extends upward and outward so that it extends generally above second section 50. It has an attachment portion 102 with one or more screw holes 104 (shown in FIG. 7) that receive fasteners 106 to attach it to device 100. Upward and outward extending portion or rib 108 has an extension 108A that includes one or more screw holes 110. Fasteners 112 (which are preferably bone screws) can pass through screw holes 110 and connect to the top of the third metacarpal bone to help prevent device 10 from rotating.

Optionally, second portion 50 has one or more receiving apertures 60 (shown in FIG. 7) that are positioned in the cannula of the third metacarpal when the second portion 50 is properly positioned in the hand. Each of the receiving apertures 60 is configured to receive the end of a fastener that is fastened to both the top bone of the third metacarpal and a receiving aperture 60 of the second portion 50 to further help prevent rotation. Another option to provide an anti-rotational structure is to eliminate the third section 100 and just insert one or more fasteners into the top bone of the third metacarpal and have each of the fasteners received in a receiving aperture 60 of the second section, as described above.

FIG. 4 shows a third section 100A with a right angle, instead of the generally S-sloped, shape of third section 100. A third section according to the invention could be integrally formed with device 10 instead of being connected thereto.

In use, an appropriate incision is made preferably lengthwise along the hand, across the wrist and along part of the forearm so that device 10 may be received under the skin. The wrist is then flexed downward and second section 50 is pressed into the cannula of the third metacarpal bone. If the third section 100 is used, and if not integrally formed with device 10, it will preferably have already been connected to device 10 prior to the placement of second section 50 into the third metacarpal bone. Third section 100 (if used) is secured to the top of the third metacarpal bone by positing screws 106 through the screw holes and securing them to the top of the third metacarpal bone, as previously described. Alternatively, screws 106 may also be received into receiving apertures formed in second portion 50 that are positioned inside the third metacarpal bone. Or, no third section 100 is used and one or more screws are positioned through the top of the third metacarpal bone and into one or more receiving apertures of the second portion 50 to help prevent rotation.

Then wrist is straightened and section 20 is positioned o the forearm and wrist. Screws 30 are then placed through the apertures 24 into the radius and/or one or more carpal bones to secure device 10.

Some specific examples of the invention are as follows:

1. A device for fusion of the wrist, the device comprising:

-   -   (a) a first substantially rigid section configured to be         positioned under the skin of the forearm and wrist, and to be         secured to at least one or more bones in the forearm; and     -   (b) a second section connected to or integrally formed with the         first section, the second section configured to be received in         the cannula of the third metacarpal bone.         2. The device of example 1 wherein the first section is an         elongated plate.         3. The device of example 1 or example 2 wherein the first         section has a downward bend between the wrist and the hand.         4. The device of example 3 wherein the downward bend is at an         angle of 10°-20°.         5. The device of any of examples 1-4 wherein the first section         has apertures that permit screws to pass through.         6. The device of any of examples 1-5 that further includes drill         guides associated with each aperture in the first section.         7. The device of any of examples 1-6 wherein the first section         is between 3.0 and 4.0 mm thick.         8. The device of any of examples 1-3 or 5-7 wherein the bend has         a drop of between 0.5 and 1.5 cm and extends along the device         for a length between 15 and 25 mm.         9. The device of any of examples 1-8 wherein the first section         is between 9 mm and 15 mm wide.         10. The device of any of examples 1-9 wherein the first section         has three or more apertures.         11. The device of any of examples 1-10 wherein the first section         has five apertures.         12. The device of any of examples 5, 10 or 11 that has an         aperture above the wrist to enable a screw to be inserted into a         bone at the wrist.         13. The device of any of examples 1 and 2 wherein the second         section is integrally formed with the first section.         14. The device of any of examples 1-13 wherein the second         section extends at an upward angle of between 10° and 20° from         the point at where it meets the first section.         15. The device of any of examples 1-13 wherein the second         section extends at an upward angle of between 15° from the point         at where it meets the first section.         16. The device of any of examples 1 and 15 wherein the second         section is between 30 and 50 mm in length.         17. The device of any of examples 1 and 15 wherein the second         section is 40 mm in length.         18. The device of any of examples 1-17 wherein the portion of         the second section that extends into the cannula of the third         metacarpal bone is between 2 mm and 4 mm in diameter.         19. The device of any of examples 1-17 wherein the portion of         the second section that extends into the cannula of the third         metacarpal bone is 3 mm in diameter.         20. The device of any of examples 1-19 that further includes an         anti-rotational section.         21. The device of example 20 wherein the anti-rotational section         is connected to the first section.         22. The device of any of examples 3, 4 or 8 that further         includes an anti-rotational section connected to the device past         the bend and on the part of the device which is to be positioned         on the hand.         23. The device of any of examples 20-22 wherein the         anti-rotational section is connected to the device by screws.         24. The device of any of examples 20-23 wherein the         anti-rotational section extends upward and outward from the         device and extends above the second section so that it can be         connected to the top of the third metacarpal bone.         25. The device of any of examples 20-24 wherein the         anti-rotational device includes one or more screw holes to allow         a screw to pass through it and connect to the top of the third         metacarpal bone.         26. The device of example 1 that includes an anti-rotational         device integrally formed therewith.         27. The device of any of examples 1-26 that is comprised of         stainless steel.         28. The device of any of examples 1-27 wherein the first section         has a length of 45-75 mm.         29. The device of any of examples wherein the first section has         a length of 60 mm.         30. The device of any of examples 1-29 wherein the device has a         length of 105-135 mm.         31. The device of any of examples 1-29 that has a length of 120         mm.         32. The device of example 1 or example 2 wherein the first         section is straight.         33. The device of any of examples 1-2 wherein the second section         extends straight from the point at which it meets the first         section.         34. The device of example 26 wherein the anti-rotational section         extends above and outward from the device and extends above the         second section so that it can be connected to the top of the         third metacarpal bone.         35. The device of example 26 or example 34 wherein the         anti-rotational device includes one or more screw holes to allow         a screw to pass through it and connect to the top of the third         metacarpal bone.         36. The device of any of examples 1-35 wherein the second         section has one or more receiving apertures that is positioned         in the cannula of the third metacarpal when the second section         is properly positioned in the hand, each of the one or more         receiving apertures for receiving a fastener positioned through         the top of the third metacarpal bone in order to secure the top         of the third metacarpal bone to the second portion, in order to         help prevent rotation of the device.         37. The device of example 36 wherein each of the fasteners is a         screw.         38. The device of example 36 wherein each of the one or more         receiving apertures is threaded to threadingly receive a screw.

Having thus described some embodiments of the invention, other variations and embodiments that do not depart from the spirit of the invention will become apparent to those skilled in the art. The scope of the present invention is thus not limited to any particular embodiment, but is instead set forth in the appended claims and the legal equivalents thereof. Unless expressly stated in the written description or claims, the steps of any method recited in the claims may be performed in any order capable of yielding the desired result. 

What is claimed is:
 1. A method of wrist fusion surgery, comprising the steps of: exposing the radius, carpals and a metacarpal bone of a wrist of a patient flexing the wrist of the patient; using a unitary implant having a distal intramedullary metacarpal portion and a proximal radial plate portion by placing the distal intramedullary portion of the implant into the metacarpal bone, wherein the proximal radial plate portion includes an aperture; straightening the wrist of the patient; placing the proximal radial plate portion onto the radius; and fixing the proximal radial plate portion to the radius by attaching a fastener through the aperture in the proximal radial plate portion into the radius, wherein the distal intramedullary metacarpal portion of the implant is offset from and joined to the proximal radial plate portion of the implant by an intermediate carpal portion, and wherein a distal end of the distal intramedullary metacarpal portion extends toward a plane defined along a longitudinal axis of the proximal radial plate portion, the distal end of the distal intramedullary metacarpal portion not coincident with the plane of the proximal radial plate portion.
 2. A method of wrist fusion surgery as set forth in claim 1, wherein flexing the wrist comprises flexing the wrist downward to expose a proximal end of the metacarpal bone.
 3. A method of wrist fusion surgery as set forth in claim 1, wherein the proximal radial plate portion is fixed to a dorsal aspect of the patient radius.
 4. A method of wrist fusion surgery as set forth in claim 1, wherein the aperture in the proximal radial plate portion includes at least one compression slot and the fastener is a screw that extends through the at least one compression slot into the radius and the method further includes the step of applying compression to the wrist by screwing the screw through the at least one compression slot.
 5. A method of wrist fusion surgery as set forth in claim 1, wherein the implant further includes an anti-rotational feature.
 6. A method of wrist fusion surgery as set forth in claim 5, wherein the anti-rotational feature is a rib on the distal intramedullary metacarpal portion.
 7. A method of wrist fusion surgery as set forth in claim 1, wherein the metacarpal is the third metacarpal.
 8. A method of wrist fusion surgery as set forth in claim 1, wherein the intermediate carpal portion includes at least one aperture and the intermediate carpal portion is fixed to the wrist by screwing a screw through the at least one aperture of the intermediate carpal portion into a carpal bone of the wrist.
 9. A method of wrist fusion surgery as set forth in claim 1, wherein a distal end of the distal intramedullary metacarpal portion extends toward and terminates prior to a plane of the proximal radial plate portion.
 10. A method of wrist fusion surgery, comprising the steps of: exposing the radius, carpals and a metacarpal bone of a wrist of a patient toward a plane using an implant having a distal intramedullary metacarpal portion and a proximal radial plate portion including an aperture, wherein the distal intramedullary metacarpal portion and the proximal radial plate portion are joined to an intermediate carpal portion such that the distal intramedullary metacarpal portion is offset from the proximal radial plate portion, by placing the distal intramedullary metacarpal portion of the implant into the metacarpal bone, wherein a distal end of the distal intramedullary metacarpal portion extends defined along a longitudinal axis of the proximal radial plate portion, the distal end of the distal intramedullary metacarpal portion not coincident with the plane of the proximal radial plate portion; placing the proximal radial plate portion onto a dorsal aspect of the radius; and fixing the proximal radial plate portion to the radius by attaching a fastener through the aperture in the proximal radial plate portion into the radius.
 11. A method of wrist fusion surgery as set forth in claim 10, further comprising the step of flexing the wrist downward in a position to expose a proximal end of the metacarpal bone.
 12. A method of wrist fusion surgery as set forth in claim 11, further comprising the step of straightening the wrist prior to placing the proximal radial plate portion onto the dorsal aspect of the radius.
 13. A method of wrist fusion surgery as set forth in claim 10, wherein the proximal radial plate portion includes at least one compression slot and the fastener is a screw that extends through the at least one compression slot into the radius and the method further includes the step of applying compression to the wrist by screwing the screw through the at least one compression slot.
 14. A method of wrist fusion surgery as set forth in claim 10, wherein the distal intramedullary metacarpal portion includes an aperture to receive a fixator and further comprising the step of using a drill guide associated with the implant to drive the fixator through the aperture in the distal intramedullary metacarpal portion. 